The
crude death rate of Kerala in 1991 was 6 (per 1000 population),
compared to the national average of 11, and an average of 10 for
low-income and 8 for middle-income countries. It is significant
to note that the crude birth rates and death rates in a ‘low-income
country’ like China and a ‘middle-income country’ like the Philippines
exceeded the corresponding rates in the ‘least developed’ region
of Kerala. Kerala’s demographic experience has attracted wide
research attention (eg (i) Zachariah, 1983; (ii) Zachariah & Irudaya
Rajan, 1994; (iii) Bhat and Irudaya Rajan, 1990; (iv) Ratcliffe,
1984; (v) Zachariah & Irudaya Rajan, 1997).

The
period during 1971-’81 witnessed the most rapid growth of medical
care institutions, especially government hospitals and dispensaries
under the Allopathic system; the total number of public sector
medical care institutions registered steady increase at the rate
of 17.5 per cent during 1955-1960, 58.2 per cent during the 1960s,
and 74.3 per cent during the 1970s. The number of medical care
institutions and the populationtion coverage of health care facility
in the major States is given in Table 4.10.

One
important feature emerging from table Table 4.10 is that of the
total number of hospitals in India, about two-thirds are in the
private sector. The share of private hospitals in Kerala works
out to be about 93 per cent. Of the total number of private hospitals
among the States, one-fifth is located in Kerala.

The
population coverage of health care facilities, ie the ratio of
population to total number of medical care institutions, is far
better for Kerala than in all the other States. That is, the number
of persons per hospital works out to be 14,264 here as compared
to the all-States average of 61,810. Except in Andhra Pradesh,
Assam, Gujarat, and Punjab the ratio exceeded one lakh people
per hospital. The high growth rate of medical care institutions
in Kerala has naturally claimed an increasing share of the State
Government’s budget. The total expenditure of this sector rose
by around three-and half times between 1969 and 1971 and by over
four times during the 1970s. The trends in the State government
expenditure on medical and public health in Kerala in recent periods
may be observed in Table 4.11

Health
transition comprises three components, viz demographic transition,
epidemiological transition, and health care transition. Kerala
has apparently made significant advances in all the three components.
Thus, the State has entered the final phase of demographic transition
as exemplified by the low death and infant mortality rates, comparable
to those of developed countries. The fall in death rates has resulted
in a rise in expectation of life at birth, and increase in the
proportion of the elderly-persons above 60 years - in the total
population. These developments have major implications. Kerala
has also been going through an epidemiological transition as reflected
in its morbidity profile.

The
picture emerging from a scrutiny of available data on morbidity
pattern is a mixed one. On the one hand, the dominant disease
group comprises acute infectious diseases including fever, diarrhoea,
and worm infestation, resembling the morbidity profile of a typical
underdeveloped country. On the other hand, the emergence of chronic
diseases like diabetes mellitus, blood pressure, heart disease,
and cancer as the major causes of death of the adult population,
resembles the situation in developed countries which have gone
through the epidemiological transition.